Wednesday, July 12, 2017

Prognostic factors and survival in melanoma patients with brain mets

We have long known that melanoma patients with brain mets respond better to SRS than WBRT.
For review here are a zillion posts about brain mets in melanoma.
There is this from the European Cancer Conference....

Metastatic melanoma: Prognostic factors and survival in patients with brain metastases
Poster Discussion: R. Board (United Kingdom) European Cancer Conference.  Jan 2017.

Brain metastases from malignant melanoma carry a poor prognosis. Novel systemic agents have improved overall survival (OS), but the value of whole-brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) remains uncertain. The melanoma-specific graded prognostic assessment (msGPA) provides useful prognostic information, but the relevance to the modern-day population has not been validated. The aim of this retrospective analysis was to identify prognostic factors for survival in patients with brain metastases from melanoma.

Since 2011, 53 patients received treatment for brain metastases from malignant melanoma at the Rosemere Cancer Centre medical oncology clinic. Data were collated [and statistically analyzed] on demographic factors and survival. 

OS from the date of diagnosis of brain metastases was 4.83 months (range = 0.27-30.4 months). On univariate analysis, BRAF, performance status and msGPA were significant prognostic indicators for OS. msGPA remained significant on multivariate analysis. OS for BRAF-positive patients receiving targeted treatment (n=22) was significantly better than for BRAF-negative patients (n=26), with median survival times of 8.2 months and 3.7 months respectively. SRS combined with systemic agents (n=16) produced an OS of 13.5 months. Patients receiving WBRT alone (n=21) had a poor prognosis (2.2 months).

The msGPA remains a valid prognostic indicator in the era of novel systemic treatments for melanoma. BRAF-positive patients receiving targeted agents during their treatment had favorable survival outcomes. WBRT alone has no role in the active management of melanoma brain metastases.

I am not clear on exactly what the authors mean by the msGPA (probably an assessment tool they have created), but what remains clear is that SRS and systemic therapy serve patients much better than those who were treated with whole brain radiation alone.  And if you recall, in this recent post:  SRS with any systemic therapy helps response in melanoma...but anti-PD-1 WITH SRS = best OS in brain mets  
Researchers reported:  Ipi with SRS = 7.5 month OS.  BRAF/MEK with SRS = 17.8 months OS.  Anti-PD-1 with SRS = 20.4 month OS.

We need to LIVE and more more WBRT!!! Ratties have provided the proof.  Let's make sure no other melanoma peeps have to suffer needlessly!!! - c

No comments:

Post a Comment